The present invention relates to a method and apparatus for joining the severed ends of intestines and the like and in particular to a method and apparatus for anastomosis.
The present invention is directed to the improvement of anastomotic surgery, by enabling the surgeon to perform a more secure anastomosis, more simply and in a shorter time than heretofore. It has particular application in all types of gastrointestinal surgery including esophagogastrostomy, gastroduodenostomy and gastrojejunostomy as well as large and small bowel anastomosis, while maintaining an inverting type of anastomosis. In this type the serosa of the bowel is turned inward so that the contact of the two pieces of bowel is established on their outer, i.e. serosal, surface. The anastomosis is said to be serosa to serosa.
To assist the surgeon in making a secure, leakproof anastomosis, various devices have been developed which are inserted into the lumens of opposing tubular sections to hold them together for suturing or clamping until secured. One such type device, first developed by John B. Murphy, comprises a pair of button-like complementary clamping members, which clamp between them the spurs or end flaps of the intestine. Such devices are primarily designed to avoid the time consuming and difficult task of suturing. However, a number of difficulties and disadvantages mitigate against their use. The most disadvantageous feature of this type of device is that they depend on the maintenance of sufficient compressive force of the clamping members on the spur so that the spur is uniformly held and necrosis occurs substantially uniformly about the wall of the intestine. When uniform necrosis does not occur which is not unusual with these devices, the clamping members fail to pass out of the intestine, and since they do not dissolve or disintegrate, may cause intestinal obstruction. Another disadvantageous feature is that all these devices significantly compromise luminal clearance and, therefore, are all prone to cause some degree of intestinal obstruction while they remain in situ.
Recently, devices have been developed in which the ends of the intestines are rolled or wrapped about dissolvable and/or disintegrating ring members and held by clamping devices and/or suturing in this condition until the juncture is healed. One such device is suggested in U.S. Pat. No. 4,182,339 and another in U.S. Pat. No. 3,974,835, both in the name of Thomas G Hardy, Jr.
These devices are also not fully advantageous. The former, which relies on separate purse string sutures to keep the two bowel ends engaged together upon the anastomotic sleeve, is insecure and prone to leak, and the latter device has been found to be too awkward and difficult to apply to be of clinical use.
It is an object of the present invention to provide a device that will permit a simple, rapid anastomosis.
Another object of the present invention is to make possible simple anastomosis in parts of the body which would normally be quite time-consuming and/or difficult.
Another object of the present invention is to make possible an anastomosis which is stronger and less likely to rupture or leak.
Another object of the present invention is to make possible an anastomosis which will always maintain a widely patent lumen which cannot stenose and is therefore less likely to obstruct.
Yet a further object of the present invention is to provide a method for performing anastomotic surgery utilizing anastomotic rings that are held in fixed position by an excisable integral frame which thereby holds the tissue members to be anastomosed at a constant short distance apart while the anastomosis is being sutured allowing for good visibility and accurate stitch placement.
A further object of the present invention is to provide anastomotic rings which can be formed of a material that will disintigrate within a specified period of time.
Yet another object of the present invention is to provide anastomotic rings painted or impregnated with a radiopaque material so that postoperative radiographic evaluation of anastomotic integrity can be made by examining the relationship between the two ring images on X-ray.
Yet another object of the present invention is to provide an anastomotic apparatus that is easily handled, inexpensive, and capable of being stocked in operating rooms in quantities for immediate use.
These and other objects of the present invention will become more apparent after consideration of the following disclosure.